The Real Problem

By Jim McVeagh 19/09/2010

The editorial in the Weekend Herald today is one of the more insightful commentaries on medicine I have seen. The Editor correctly points out that many of the percieved failings of the medical fraternity have little to do with the facilities, number of staff or quality of clinical acumen.

In today’s paper, members of the surgery department respond to that case and another reported this week. In an open letter, they address issues of medical treatment and physical building and bed limitations.

But they do not discuss the distress the young woman suffered from incidents of offhand or negligible communication, or why buzzer calls for pain relief might take 90 minutes to be answered. The surgeons write, curiously, of “perceived delays in care” at their hospital.

Improvements in administration and resourcing cannot simply be about more heads, bricks and mortar. They must also change attitudes.

Unfortunately, the same newspaper has yet another medical misery story, somewhat counteracting this point. As usual, as you read through the story, you see signs that there is another side to it. The original injury was month ago, making it unlikely that this was the first episode of pain (recurrent pain is usually seen as considerably less urgent than new pain). Mr. Wheeler kept leaving the hospital of his own accord, interrupting the course of his investigation. I now from experience that going home and coming again the next day is a bad move – it just resets the doctor’s time clocks to zero.

This is not to say that Mr. Wheeler was treated well – and that is the real point of the story: not that the clinical input that he received was bad, but that the human interface with that clinical world was poor. Mr. Wheeler was treated like a patient, rather than a person. This is not a plea for touchy-feely patient care. I do not think all the cultural awareness campaigns and consumer service courses in the world are going to help this.

What we really need is for doctors and nurses to be sick.

Once every five years it should be obligatory for clinicians to spend one or two nights in hospital having investigations done to them. Unfortunately, even this is not really adequate, because most people in hospital have something wrong with them. Often something undiagnosed as yet.

The problem is that it almost impossible to appreciate what a person in that situation is feeling, unless you’ve been there. It is scary. It is unpleasant. It is lonely. It is disorientating. I spent a night in hospital for an episode of dizziness late last year. I spent 6 hours in the emergency department and spoke to a doctor twice, two nurses and an orderly. For more than two hours, no-one spoke to me at all. Fortunately, I had some inkling of what was going on as I have worked for years in emergency departments, but I can imagine what someone with no medical knowledge would be going through. Yet all that was happening was that we were waiting for a CT scan. The first I heard about this was when the orderly told me that’s where we were going.

Overnight, I had an IV pump and a remote heart monitor squawking at me every time I moved in bed. I know that these were put on me as a precautionary measure, but that was not explained to me. It was not explained to the gentleman in the bed next to me either, so this was not a case of assuming I knew what they were for.

All of this was good medicine. The doctors and nurses provided me with excellent care. Unfortunately, they neglected to treat me as anything less than a case. a problem to solve. And yet it would have taken very little to change the experience. A friendly head round the curtain occasionally. The doctor taking time to go over my blood tests and explain the plan from there. An occasional update on when the ward bed would be ready. An explanation of the monitoring system. Some idea of when the specialist would arrive. A little more quiet during the night shift. Some idea of when my discharge papers might be ready.

It is that kind of simple information that punctuates the boredom of hospital and gives you a sense of the movement of time. It helps you feel that you are making progress towards recovery. There is evidence that a well-informed patient requires less nursing help and less analgesia than a confused, frightened one.

We often excuse our poor experience in hospital as a result of poor facilities and low nursing and doctor numbers, but the depressing truth of the matter is that these are not the real problem. Doctors and nurses alike might like to remember that it only takes 20-30 seconds to update a patient and make sure that they don’t need anything such as water or pain relief. While I appreciate the time constraints that medical personnel have and the enormous amount of paperwork we have to get through, perhaps we need to focus a little more on the people we are supposed to be there for. There is more to medicine than clinical accuracy.

Note: This is a general observation. There are some doctors and nurses who are simply brilliant at patient interaction. Teach your fellow clinicians, please.


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